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Insured or not, Americans have trouble getting medical care
Scripps Howard News Service


July 02, 2008

Whether you're insured or not, the odds that you or a member of your family will not get or delay getting needed medical care are increasingly against you.

A recent report from the Center for Studying Health System Change in Washington finds that 1 in 5 Americans had problems getting medical care in 2007, up significantly from the 1 in 7 reported from a similar national survey in 2003.

That translates to more than 23 million people going without medical care and about 36 million people delaying care, according to the survey, which looked at the experience of 18,000 people.

To be sure, uninsured people were still 3 times more likely to report going without care than insured people. But the proportion of people with insurance reporting unmet health needs grew at twice the rate -- 62 percent -- compared to the 33 percent increase among the uninsured.

"We've been supporting these surveys since 1976, and all those years, it's been true that the uninsured get much less care than the insured. This latest survey shows that being insured no longer offers that assurance for many people," said David Colby, vice president for research and evaluation at the Robert Wood Johnson Foundation, which sponsored the study.

"The American health care system is broken, and with each passing year, more Americans are falling behind when it comes to getting the medical care they need."

The survey suggests that the reasons for both the uninsured and those with coverage failing to get timely health care are not so different. Cost was cited 90 percent of the time for people with no coverage, but also by more than 60 percent of people with insurance.

"For many people with insurance, the deductibles and out-of-pocket limits are viewed as too high, presenting much the same economic barrier as the uninsured face," said Peter Cunningham, a senior fellow at the center and co-author of the study.

Of course, if you're paying some or all the insurance bill, it doesn't help that the average cost for family coverage rose nearly 30 percent (to $2,500) between 2001 and 2005, a period when family incomes rose just 3 percent, according to another recent Robert Wood Johnson report.

Another June study, from The Commonwealth Fund, found that the number of adults (aged 19-64) considered "underinsured" -- with coverage, but very high medical expenses relative to their incomes -- rose from 16 million to 25 million between 2003 and 2007.

"Today, you can have health insurance, but still go bankrupt if you get sick," said Cathy Schoen, lead author of the study and a senior vice president of Commonwealth.

The Health System Change study also found that people with the poorest health had the most difficulty getting needed care.

A Consumer Reports analysis published last month found that many patients are being forced to overdose on debt to pay for care, with about $45 billion in medical bills going on plastic today. That number is expected to rise to more than $150 billion over the next seven years. The study cited numerous examples of predatory lending to people trying to cover their medical bills.

"Clearly, we need a system where all needed care is available, but we also need to cut the over treatment that exists in the system," said Gail Shearer, president of Consumers Union. "We need a system that consistently provides appropriate quality care without unfair financial burdens."

Some insured people report health plan obstacles, such as pre-certification for tests or specialists, or trying to see doctors who are not in their plan, as standing in the way of care.

But more (almost 65 percent) said they had difficulty getting care because they could not get a timely appointment or couldn't get to a doctor's office or clinic during business hours.

While more nurse practitioners and retail health clinics are part of the trend to address that part of the access problem, the fact remains that primary care doctors are in short supply in many parts of the country.

American medical schools graduated 16,000 new doctors last year. Only about 1,000 are headed into family medicine.



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